3. Ankle Sprains
Grade 3 - ant drawer - talar tilt - lig damage instability - swelling - loss of function - loss of ankle motion
- ant drawer: POS - talar tilt: POS - lig damage instability: Complete tear, need sx - swelling: >2cm - loss of function: near total - loss of ankle motion: >10deg
Grade 2 ankle sprain - ant drawer - talar tilt - lig damage instability - swelling - loss of function - loss of ankle motion
- ant drawer: POS - talar tilt: neg - lig damage instability: partial tear, slight - swelling: 0.5-2cm - loss of function: some - loss of ankle motion: 5-10deg
Grade 1 ankle sprain - ant drawer - talar tilt - lig damage instability - swelling - loss of function - loss of ankle motion
- ant drawer: neg - talar tilt: neg - lig damage instability: stretchedl lig, no instability - swelling: =<0.5cm - loss of function: minimal - loss of ankle motion: =<5deg
when does inflammation subside for Grade 1 Grade 2 Grade 3
1 and 2: 2-4 days 3: 1-2w
when can you start progressive loading/sensorimotor training with Grade 1 Grade 2 Grade 3
1 and 2: 2-6w 3: 8-24w
freq of high ankle sprains
1-11% of all ankle sprains 40-74% in athletes ankle sprains
what is the recurrence rate of ankle sprains
40%
most common lig sprained in LCL ankle sprain - %
ATF- PF and inversion 73%
2 secondary lig for LCL ankle sprain and the test
Calcaneal fib- calc varus stretch (Medial Talar Telt Stress test) Posterior Talofib - evert and PF to pinch
Most common mechanism of injury for a lateral ankle sprain is... - FF (add/abd) - HF (inv/ever) - tib (ER/IR) - ankle (PF/DF)
FF add HF inv tib ER PF
exam test for chronic high ankle sprain
Kleiger test: ER stress test
what is the A level evidence ankle sprain intervention for progressive loading/sensorimotor training phase
Manual Therapy: mobs, manip
what injury is associated with syndesmosis injury
Med collateral or deltoid lig sprain during eversion
what 2 differential osseous injuries can occur during ankle sprain
Ottawa Ankle Rules Osteochondral lesion of talus
how to test for eversion ankle sprain
PF and evert
what is contraindicated during acute ankle sprain phase
US
Grade 1 sprain tx - WB? - crutches? - type of support - time lost from activity
WBAT crutches 0-4days ankle stabilization lose 4-14 days
Grade 2 sprain tx - WB? - crutches? - type of support - time lost from activity
WBAT crutches 1-3w ankle stabilization lose 2-6 w
Grade 3 sprain tx - WB? - crutches? - type of support - time lost from activity
WBAT crutches 3-6w walking boot 3w-->ankle stab 3w lose 4-26w
Mechanical instability compared to FAI
all the same BUT Positive Drawer sign is present
ICF for ankle ligament sprains
ankle stability and movement coordination impairments
gold standard for ankle sprains
ant drawer test
test for ATF sprain
anterior drawer test 20deg PF and pull talus forward excessive motion or pain for positive
positive impingement sign test indicates what
anterolateral ankle impingement of synovium btw talus and tib also ATF lig arthroscopy could be needed
Chronic Ankle instability CAI - develops when - occurence rate - 2 categories
develop after ankle sprains occurence in 20-40% of ankle sprain 1. FAI (functional ankle instability) 2. MI (mechanical instabilty)
high ankle sprain causes what to distal tibfib jt
diastasis or widening normally ligs prevent widening during WB
FAI - due to what - what deficits are present - is it associated with joint laxity
due to recurrent ankle sprains balance and sensorimotor deficits present NOT ASSOCIATED WITH JT LAXITY
what are the 3 A level evidence ankle sprain interventions for ACUTE phase
early WB w external support Cryo Therapeutic exercise
common mechanism of injury for high ankle sprain
forced excessive ankle motion w foot planted
will ant drawer test be positive for Functional or mechanical ankle instability
only for mechanical
common symptom of high ankle sprain
pain prox to TCJ cannot push off
during a lateral ankle sprain what muscles and nerves are also injured
peroneal muscles common fib n sural n
risk factors for ankle sprains
prev hx no external support after injury no warm up decr DF ROM No balance/prop program after injury Great Calcaneal varus Hip Ext weakness
what is the most common mechanism of injury for ankle sprains
sport athletics 45%
exam test for acute high ankle sprain
squeeze test: compress calf at midpoint
during a medial ankle sprain what muscles and nerves are also injured
tib posterior tibial n
Greater Calcaneal Valgus or Varus is a risk factor for ankle sprains and why
varus due to standing on the outside of the feet